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Massetti GM, Stamatakis C, Charania S, Annor FB, Rice CE, Hegle J, Ramphalla P, Sechache M, Motheo M. Prevalence of Functional Disabilities and Associations Among Disabilities, Violence, and HIV Among Adolescents and Young Adults in Lesotho. J Epidemiol Glob Health 2024; 14:223-233. [PMID: 38498114 PMCID: PMC11043310 DOI: 10.1007/s44197-023-00184-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/22/2023] [Indexed: 03/20/2024] Open
Abstract
INTRODUCTION Lesotho has the second-highest prevalence of HIV. Despite progress in achieving HIV epidemic control targets, inequities persist among certain groups, particularly associations between disability, HIV, and violence. We assessed the prevalence of disability and examined associations between disability and HIV and violence using data from the 2018 Lesotho Violence Against Children and Youth Survey (VACS). METHODS Lesotho VACS was a nationally representative survey of females and males ages 13-24. We assessed the associations between disability status and HIV, sexual risk behaviours, and violence using logistic regression, incorporating survey weights. RESULTS Weighted functional disability prevalence was 14.1% for females (95% confidence interval [CI] 12.7-15.4) and 7.3% for males (5.3-9.2). Compared with females with no disabilities, females with disabilities had higher odds of being HIV positive (adjusted odds ratio [aOR] 1.92, 1.34-2.76), having transactional sex (aOR 1.79, 1.09-2.95), and experiencing any lifetime violence (aOR 2.20, 1.82-2.65), sexual violence (aOR 1.77, 1.36-2.31), emotional violence (2.02. 1.61-2.53), physical violence (aOR 1.85, 1.54-2.24), witnessing interparental violence (aOR 1.71, 1.46-2.01), and witnessing community violence (aOR 1.52, 1.26-1.84). Males with disabilities had higher odds of having transactional sex (aOR 4.30, 1.35-13.73), having recent multiple sex partners (aOR 2.31, 1.13-4.75), experiencing emotional violence (aOR 2.85, 1.39-5.82), and witnessing interparental violence (aOR 1.78, 1.12-2.84). HIV models for males did not converge due to low numbers. CONCLUSION Findings emphasize the importance of inclusion and accessibility for adolescents and young adults with disabilities in prevention and services for violence and HIV. Ending HIV in Lesotho depends on addressing the vulnerabilities that lead to potential infection including violence and ensuring equitable services for all.
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Affiliation(s)
- Greta M Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA.
| | - Caroline Stamatakis
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Sana Charania
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA, 30341, USA
| | - Catherine E Rice
- Divison of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Atlanta, USA
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, USA
| | - Puleng Ramphalla
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Maseru, Lesotho
| | | | - Mookho Motheo
- Ministry of Social Development, Government of Lesotho, Maseru, Lesotho
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Danielson ML, Kassab HD, Lee M, Owens JS, Evans SW, Lipton C, Charania S, Young HE, Kubicek LF, Flory K, Cuffe SP. The Utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System and Strengths and Difficulties Questionnaire in Predicting Mental Disorders in the Project to Learn About Youth-Mental Health. Psychol Sch 2023; 60:2320-2341. [PMID: 37970221 PMCID: PMC10642258 DOI: 10.1002/pits.22856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
We examined the predictive utility of the Behavior Assessment System for Children-2 Behavioral and Emotional Screening System (BASC-2-BESS) and Strengths and Difficulties Questionnaire (SDQ) in identifying students with a mental disorder. Data were collected in a two-stage study over 34 months with kindergarten-12th grade (K-12) students (aged 5-19 years) in four U.S. school districts. In Stage 1, teachers completed the BASC-2-BESS and the SDQ. In Stage 2, parents of 1,054 children completed a structured diagnostic interview to determine presence of a mental disorder. Results suggest that teacher versions of the BASC-2-BESS and SDQ have modest utility in identifying children meeting criteria for a mental disorder based on parent report. Area Under the Curve (AUC) statistics representing prediction of any externalizing disorder (.73 for both measures) were higher than the AUCs predicting any internalizing disorder (.58 for both measures). Findings can inform the use of teacher report in mental health screening, specifically the selection of measures when implementing screening procedures.
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Affiliation(s)
- Melissa L Danielson
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
| | | | - Mary Lee
- Department of Psychology, Ohio University, Athens, OH
| | | | | | - Corey Lipton
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Sana Charania
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Hayley Elia Young
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta GA
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lorraine F Kubicek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kate Flory
- Department of Psychology, University of South Carolina, Columbia, SC
| | - Steven P Cuffe
- Department of Psychiatry, University of Florida College of Medicine, Jacksonville, FL
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Hutchins H, Robinson L, Charania S, Ghandour R, Hirsh-Pasek K, Zubler J. Psychometric Assessment of Pilot Language and Communication Items on the 2018 and 2019 National Survey of Children's Health. Acad Pediatr 2022; 22:1133-1141. [PMID: 34968678 PMCID: PMC9694117 DOI: 10.1016/j.acap.2021.12.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Until recently, normative data on language and communication development among children in the United States have not been available to inform critical efforts to promote language development and prevent impairments. This study represents the first psychometric assessment of nationally representative data derived from a National Survey of Children's Health (NSCH) pilot measure of language and communication development among children ages 1 to 5 years. METHODS We analyzed 14,573 parent responses to language and communication items on the 2018 and 2019 NSCH to evaluate whether the newly added 11 items represent a single latent trait for language and communication development and to determine normative age of success on each item. We applied weighted, one-parameter Item Response Theory to rate and cluster items by difficulty relative to developmental language ability. We examined differential item functioning (DIF) using weighted logistic regression by demographic factors. RESULTS Together, exploratory factor analysis resulting in a single factor > 1 and explaining 93% of the variance and positive correlations indicated unidimensionality of the measure. Item characteristic curves indicated groupings were overall concordant with proposed milestone ages and representative of an approximate 90% success cut-point by child age. Indicated normative age cut-points for 3 of the items differed slightly from proposed milestone ages. Uniform DIF was not observed and potential nonuniform DIF was observed across 5 items. CONCLUSIONS Results have the potential to enhance understanding of risk and protective factors, inform efforts to promote language and communication development, and guide programmatic efforts on early detection of language delays.
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Affiliation(s)
- Helena Hutchins
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (H Hutchins and L Robinson), Atlanta, Ga; Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs (H Hutchins), Oak Ridge, Tenn.
| | - Lara Robinson
- Child Development Studies Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (H Hutchins and L Robinson), Atlanta, Ga
| | - Sana Charania
- Early Hearing Detection and Intervention Team, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (S Charania), Atlanta, Ga
| | - Reem Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration (R Ghandour), Rockville, Md
| | - Kathy Hirsh-Pasek
- Department of Psychology, Temple University (K Hirsh-Pasek), Philadelphia, Pa; Brookings Institution (K Hirsh-Pasek), Washington, DC
| | - Jennifer Zubler
- Eagle Global Scientific (J Zubler), San Antonio, Tex; Learn the Signs, Act Early Program, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (J Zubler), Atlanta, Ga
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Silvestri D, Goutos D, Lloren A, Zhou S, Zhou G, Farietta T, Charania S, Herrin J, Peltz A, Lin Z, Bernheim S. Factors Associated With Disparities in Hospital Readmission Rates Among US Adults Dually Eligible for Medicare and Medicaid. JAMA Health Forum 2022; 3:e214611. [PMID: 35977231 PMCID: PMC8903116 DOI: 10.1001/jamahealthforum.2021.4611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/02/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Low-income older adults who are dually eligible (DE) for Medicare and Medicaid often experience worse outcomes following hospitalization. Among other federal policies aimed at improving health for DE patients, Medicare has recently begun reporting disparities in within-hospital readmissions. The degree to which disparities for DE patients are owing to differences in community-level factors or, conversely, are amenable to hospital quality improvement, remains heavily debated. Objective To examine the extent to which within-hospital disparities in 30-day readmission rates for DE patients are ameliorated by state- and community-level factors. Design Setting and Participants In this retrospective cohort study, Centers for Medicare & Medicaid Services (CMS) Disparity Methods were used to calculate within-hospital disparities in 30-day risk-adjusted readmission rates for DE vs non-DE patients in US hospitals participating in Medicare. All analyses were performed in February and March 2019. The study included Medicare patients (aged ≥65 years) hospitalized for acute myocardial infarction (AMI), heart failure (HF), or pneumonia in 2014 to 2017. Main Outcomes and Measures Within-hospital disparities, as measured by the rate difference (RD) in 30-day readmission between DE vs non-DE patients following admission for AMI, HF, or pneumonia; variance across hospitals; and correlation of hospital RDs with and without adjustment for state Medicaid eligibility policies and community-level factors. Results The final sample included 475 444 patients admitted for AMI, 898 395 for HF, and 1 214 282 for pneumonia, of whom 13.2%, 17.4%, and 23.0% were DE patients, respectively. Dually eligible patients had higher 30-day readmission rates relative to non-DE patients (RD >0) in 99.0% (AMI), 99.4% (HF), and 97.5% (pneumonia) of US hospitals. Across hospitals, the mean (IQR) RD between DE vs non-DE was 1.00% (0.87%-1.10%) for AMI, 0.82% (0.73%-0.96%) for HF, and 0.53% (0.37%-0.71%) for pneumonia. The mean (IQR) RD after adjustment for community-level factors was 0.87% (0.73%-0.97%) for AMI, 0.67% (0.57%-0.80%) for HF, and 0.42% (0.29%-0.57%) for pneumonia. Relative hospital rankings of corresponding within-hospital disparities before and after community-level adjustment were highly correlated (Pearson coefficient, 0.98). Conclusions and Relevance In this cohort study, within-hospital disparities in 30-day readmission for DE patients were modestly associated with differences in state Medicaid policies and community-level factors. This suggests that remaining variation in these disparities should be the focus of hospital efforts to improve the quality of care transitions at discharge for DE patients in efforts to advance equity.
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Affiliation(s)
- David Silvestri
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Demetri Goutos
- The Yale Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut
| | - Anouk Lloren
- Mathematica Policy Research, Cambridge, Massachusetts
| | - Sheng Zhou
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut,The Yale Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut
| | - Guohai Zhou
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Sana Charania
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Jeph Herrin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut,Flying Buttress Associates, Charlottesville, Virginia
| | - Alon Peltz
- The Yale Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut,Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Zhenqiu Lin
- The Yale Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Susannah Bernheim
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut,The Yale Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven, Connecticut,Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Ema S, Charania S, Deng X, Rose C, Mason CA, Gaffney M, Culpepper B, Lo M, Tran T, Coverstone K, Fort M. Assessing Impact of COVID-19 Pandemic on Receipt and Timeliness of Newborn Hearing Screening and Diagnostic Services Among Infants Born in Four States. J Early Hear Detect Interv 2022; 7:6-15. [PMID: 38617119 PMCID: PMC11009938 DOI: 10.26077/05f5-2ffc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
The study compares receipt and timeliness of newborn hearing screening and follow-up diagnostic services between the pre-pandemic birth cohort and the pandemic birth cohort in four participating states. Findings from this study will help inform state Early Hearing Detection and Intervention (EHDI) programs in the future should a major public health event occur again.
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Affiliation(s)
- Suhana Ema
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sana Charania
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Xidong Deng
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Charles Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Marcus Gaffney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Michael Lo
- Georgia Early Hearing Detection and Intervention, Atlanta, GA
| | - Tri Tran
- Louisiana Early Hearing Detection and Intervention, New Orleans, LA
| | | | - Marcia Fort
- North Carolina Early Hearing Detection and Intervention, Raleigh, NC
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Suthar AB, Schubert S, Garon J, Couture A, Brown AM, Charania S. Coronavirus Disease Case Definitions, Diagnostic Testing Criteria, and Surveillance in 25 Countries with Highest Reported Case Counts. Emerg Infect Dis 2022; 28:148-156. [PMID: 34932450 PMCID: PMC8714223 DOI: 10.3201/eid2801.211082] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We compared case definitions for suspected, probable, and confirmed coronavirus disease (COVID-19), as well as diagnostic testing criteria, used in the 25 countries with the highest reported case counts as of October 1, 2020. Of the identified countries, 56% followed World Health Organization (WHO) recommendations for using a combination of clinical and epidemiologic criteria as part of the suspected case definition. A total of 75% of identified countries followed WHO recommendations on using clinical, epidemiologic, and diagnostic criteria for probable cases; 72% followed WHO recommendations to use PCR testing to confirm COVID-19. Finally, 64% of countries used testing eligibility criteria at least as permissive as WHO. We observed marked heterogeneity in testing eligibility requirements and in how countries define a COVID-19 case. This heterogeneity affects the ability to compare case counts, transmission, and vaccine effectiveness, as well as estimates derived from case surveillance data across countries.
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7
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Charania S. How Medicaid and States Could Better Meet Health Needs of Persons Experiencing Homelessness. AMA J Ethics 2021; 23:E875-880. [PMID: 34874257 DOI: 10.1001/amajethics.2021.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
An estimated 580 000 people experienced homelessness on any single night in the United States in 2020. This article argues that, to address these persons' unmet needs, Medicaid should collaborate with clinicians and state programs to provide permanent supportive housing and housing support services to individuals experiencing homelessness. Access to shelter can improve health outcomes for individuals experiencing homelessness and reduce overall health care costs.
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Affiliation(s)
- Sana Charania
- Student at the George Washington University's Milken Institute School of Public Health in Washington, DC
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Kamau F, Kgokane B, Mthethwa E, Mashele N, Everson F, Goswami N, De Boever P, Nawrot T, Charania S, Webster I, Strijdom H. HIV-infected adults are predisposed to proatherogenic biochemical changes. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Claussen AH, Robinson LR, Kaminski JW, Charania S, Holbrook JR, So M, Ghandour R, Smith C, Satterfield-Nash A, Peacock G, Boyle C. Factors Associated with Self-regulation in a Nationally Representative Sample of Children Ages 3-5 Years: United States, 2016. Matern Child Health J 2020; 25:27-37. [PMID: 33219911 DOI: 10.1007/s10995-020-03039-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to describe self-regulation (the ability to influence or control one's thoughts or behavior in response to situational demands and social norms) in children ages 3-5 years using a nationally representative sample and examine risk and protective factors to identify opportunities to support children and families. METHODS Using a cross-sectional design, we examined data from a parent-reported pilot measure of self-regulation from the 2016 National Survey of Children's Health (NSCH). We compared U.S. children aged 3-5 years who were described by parents as "on track" with self-regulation development with children who were not. In addition, we described how health care and developmental services, community, family, and child health and development factors are associated with children's self-regulation. RESULTS The majority of children (4 of 5) were described by their parents to be developmentally on track with self-regulation. Compared to children described as not on track, children described as on track more often lived in financially and socially advantaged environments and less often experienced family adversity. They also had other positive health and development indicators, whether or not they were receiving developmental services. However, only half of children not on track received developmental surveillance, and only 1 in 4 children described as not on track received educational, mental health, or developmental services. CONCLUSION The findings are a step towards using self-regulation as an indicator of healthy child development and as a potential strategy to identify groups of children who may need additional support.
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Affiliation(s)
- Angelika H Claussen
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA.
| | - Lara R Robinson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Jennifer W Kaminski
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Sana Charania
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Joseph R Holbrook
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Marvin So
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Reem Ghandour
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Camille Smith
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Ashley Satterfield-Nash
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - Georgina Peacock
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
| | - Coleen Boyle
- Office of the Director, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, GA, USA
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Herrin J, Peltz A, Zhou S, Du C, Barbo A, Charania S, Schwartz M, Lin Z, Bernheim S. Illuminating Hospital Disparities in Readmissions for Patients with Social Risk Factors: Comparing Hospital Performance Using Two Different Approaches. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- J. Herrin
- School of Public Health Yale University New Haven CT United States
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - A. Peltz
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
- Yale University New Haven CT United States
| | - S. Zhou
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - C. Du
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - A. Barbo
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - S. Charania
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - M.K. Schwartz
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - Z. Lin
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
| | - S. Bernheim
- Yale New Haven Health Services Corporation – Center for Outcomes Research and Evaluation (YNHHSC/CORE) New Haven CT United States
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Everson F, Martens DS, Nawrot TS, Goswami N, Mthethwa M, Webster I, Mashele N, Charania S, Kamau F, De Boever P, Strijdom H. Personal exposure to NO 2 and benzene in the Cape Town region of South Africa is associated with shorter leukocyte telomere length in women. Environ Res 2020; 182:108993. [PMID: 31830692 DOI: 10.1016/j.envres.2019.108993] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/06/2019] [Accepted: 12/01/2019] [Indexed: 06/10/2023]
Abstract
Air pollution exposure is a major global health concern and has been associated with molecular aging. Unfortunately, the situation has not received much attention in the African region. The aim of this study was to investigate whether current personal ambient NO2 and benzene, toluene, ethyl-benzene and xylenes (ortho (o)-, meta (m)- and para (p)-xylene (BTEX) exposure is associated with leukocyte telomere length (LTL), a marker of molecular ageing, in apparently healthy women (mean ± SD age: 42.5 ± 13.4 years) residing in the Cape Town region of South Africa. The repeated measures study collected data from 61 women. Seven-day median (interquartile range (IQR)) personal NO2 and BTEX exposure levels were determined via compact passive diffusion samplers carried on the person prior to baseline (NO2: 14.2 (9.4-17.2) μg/m³; Benzene: 3.1 (2.1-5.3) μg/m³) and 6-month follow-up (NO2: 10.6 (6.6-13.6) μg/m³; Benzene: 2.2 (1.3-4.9) μg/m³) visits. LTL was measured at baseline and follow-up using a real-time PCR method. Multiple linear mixed model analyses (adjusting for age, body mass index, smoking, employment status, level of education and assessment visit) showed that each IQR increment increase in NO2 (7.0 μg/m³) and benzene (3.3 μg/m³) was associated with -7.30% (95% CI: -10.98 to -3.46%; p < 0.001) and -6.78% (95% CI: -11.88 to -1.39%; p = 0.015) difference in LTL, respectively. The magnitude of these effects of NO2 and benzene corresponds to the effect of an increase of 10.3- and 6.0-year in chronological age on LTL. Our study shows that personal exposures to NO2 and benzene are associated with molecular ageing as indicated by LTL in healthy women residing in the Cape Town region.
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Affiliation(s)
- Frans Everson
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, 3590, Diepenbeek, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, 3590, Diepenbeek, Belgium.
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, 8036, Graz, Austria
| | - Mashudu Mthethwa
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Ingrid Webster
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Nyiko Mashele
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Sana Charania
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Festus Kamau
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, 3590, Diepenbeek, Belgium; Health Unit, Flemish Institute for Technological Research (VITO), 2400, Mol, Belgium
| | - Hans Strijdom
- Centre for Cardio-metabolic Research in Africa, Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 8000, South Africa
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12
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Lloren A, Liu S, Herrin J, Lin Z, Zhou G, Wang Y, Kuang M, Zhou S, Farietta T, McCole K, Charania S, Dorsey Sheares K, Bernheim S. Measuring hospital-specific disparities by dual eligibility and race to reduce health inequities. Health Serv Res 2020; 54 Suppl 1:243-254. [PMID: 30666634 PMCID: PMC6341208 DOI: 10.1111/1475-6773.13108] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To propose and evaluate a metric for quantifying hospital‐specific disparities in health outcomes that can be used by patients and hospitals. Data Sources/Study Setting Inpatient admissions for Medicare patients with acute myocardial infarction, heart failure, or pneumonia to all non‐federal, short‐term, acute care hospitals during 2012‐2015. Study Design Building on the current Centers for Medicare and Medicaid Services methodology for calculating risk‐standardized readmission rates, we developed models that include a hospital‐specific random coefficient for either patient dual eligibility status or African American race. These coefficients quantify the difference in risk‐standardized outcomes by dual eligibility and race at a given hospital after accounting for the hospital's patient case mix and proportion of dual eligible or African American patients. We demonstrate this approach and report variation and performance in hospital‐specific disparities. Principal Findings Dual eligibility and African American race were associated with higher readmission rates within hospitals for all three conditions. However, this disparity effect varied substantially across hospitals. Conclusion Our models isolate a hospital‐specific disparity effect and demonstrate variation in quality of care for different groups of patients across conditions and hospitals. Illuminating within‐hospital disparities can incentivize hospitals to reduce inequities in health care quality.
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Affiliation(s)
- Anouk Lloren
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
| | - Shuling Liu
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
| | - Jeph Herrin
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
| | - Guohai Zhou
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Section of Cardiovascular Medicine, Department of Medicine, Center for Outcomes Research and Evaluation (CORE), Yale Univerity, New Haven, Connecticut
| | - Meng Kuang
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Sheng Zhou
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Thalia Farietta
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Kerry McCole
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Sana Charania
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
| | - Karen Dorsey Sheares
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Section of Pediatrics, Department of Pediatrics, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Susannah Bernheim
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, Connecticut.,Section of General Internal Medicine, Department of Internal Medicine, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut
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13
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Strijdom H, Essop MF, Goswami N, De Boever P, Webster I, Everson F, Kamau FM, Charania S, Nawrot TS. P5340HIV-infected participants on combination ART (tenofovir, emtricitabine, efavirenz) have improved endothelial function and smaller retinal venular calibers compared to treatment naive participants. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cumulative data from several studies suggest that HIV-infected populations have a 2-fold increased cardiovascular risk. Evidence is also pointing to a link between HIV and early vascular changes, including endothelial dysfunction and subclinical atherosclerosis. There is a paucity of data from sub-Saharan Africa (the epicenter of the global HIV burden and a region with a rapidly increasing cardiovascular disease [CVD] incidence); furthermore, the contribution of specific combination ART (c-ART) regimens to HIV-related CVD and early vascular changes remain unclear.
Purpose
To investigate the association between HIV-infection, c-ART (TDF+FTC+EFV), CVD risk and vascular markers of CVD in an adult cohort in South Africa.
Methods
Cross-sectional study, participants assigned to 3 groups: HIV-free (HIV−), HIV-infected ART naïve (HIV+/−) and HIV-infected on ART (HIV+/+). Data collection: demographic information, anthropometrics, CVD risk factors, and blood chemistry. Vascular endpoints assessed: brachial artery flow-mediated dilatation (FMD), carotid intima-media thickness (C-IMT) and retinal microvascular calibers.
Results
Cohort size: n=427 (HIV− n=148; HIV+/− n=69; HIV+/+ n=210), mean age: 39.4 years, 68.9% females. Analysis of cardiovascular risk showed no differences in smoking and alcohol consumption, and blood pressure was unaffected by HIV-status. The untreated HIV group had a high % participants with clinically low HDL-cholesterol levels, whereas c-ART seemed to reduce the prevalence (HIV+/−: 58% vs 31% in HIV− and 26% in HIV+/+; p<0.01). Prevalence of hyper-LDL-cholesterolemia and hypertriglyceridemia were similar. High sensitivity CRP levels were unaffected by HIV-status. Markers of end-organ damage showed renal involvement in the HIV+ groups (median regression of urine albumin-creatinine ratio in HIV+/+ and HIV+/− vs HIV−: Beta±SEM: 0.5±0.3 and 0.8±0.2 in HIV+/+ and HIV+/− respectively, p=0.02; adjusted for age, gender and ethnicity), as well as hepatic injury in the treated group (gamma-GT in HIV+/+ vs HIV−: Beta±SEM: 23.3±4.4, p<0.01, adjustment as above). Multiple regression of vascular markers showed increased FMD in HIV+/+ vs HIV+/− (Beta±SEM: 1.8±0.8, p=0.01; adjusted for age, gender, ethnicity and BMI), and decreased central retinal venular equivalent (CRVE) in HIV+/+ vs HIV+/− (Beta±SEM: −11.9±3.8, p=0.002) and vs HIV− (Beta±SEM: −7.1±3.2, p=0.03), adjustment as above. Carotid IMT was not affected by HIV or treatment status.
Conclusions
Combination ART consisting of TDF+FTC+EFV conferred vascular protection in HIV-infected participants as shown by improved endothelial function (increased FMD) and smaller CRVE compared to ART naïve counterparts. There was no evidence of subclinical atherosclerosis involvement (C-IMT). The vasculoprotective effects in the treated group were supported by a favourable HDL-cholesterol profile, despite unchanged inflammation (hs-CRP), and evidence of renal and hepatic impairment.
Acknowledgement/Funding
Dept of Science and Technology (South Africa); National Research Foundation (South Africa); Belgian Science Policy, Belgium; Austrian Grants Agency.
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Affiliation(s)
- H Strijdom
- University of Stellenbosch, Division of Medical Physiology, Cape Town, South Africa
| | - M F Essop
- University of Stellenbosch, Dept of Physiological Sciences, Stellenbosch, South Africa
| | - N Goswami
- Medical University of Graz, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Graz, Austria
| | | | - I Webster
- University of Stellenbosch, Division of Medical Physiology, Cape Town, South Africa
| | - F Everson
- University of Stellenbosch, Division of Medical Physiology, Cape Town, South Africa
| | - F M Kamau
- University of Stellenbosch, Division of Medical Physiology, Cape Town, South Africa
| | - S Charania
- University of Stellenbosch, Division of Medical Physiology, Cape Town, South Africa
| | - T S Nawrot
- Hasselt University, Centre for Environmental Sciences, Hasselt, Belgium
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Everson F, De Boever P, Nawrot TS, Goswami N, Mthethwa M, Webster I, Martens DS, Mashele N, Charania S, Kamau F, Strijdom H. Personal NO 2 and Volatile Organic Compounds Exposure Levels are Associated with Markers of Cardiovascular Risk in Women in the Cape Town Region of South Africa. Int J Environ Res Public Health 2019; 16:E2284. [PMID: 31261612 PMCID: PMC6651077 DOI: 10.3390/ijerph16132284] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/09/2019] [Accepted: 06/15/2019] [Indexed: 12/24/2022]
Abstract
Exposure to ambient NO2 and benzene, toluene ethyl-benzene and m+p- and o-xylenes (BTEX) is associated with adverse cardiovascular effects, but limited information is available on the effects of personal exposure to these compounds in South African populations. This 6-month follow-up study aims to determine 7-day personal ambient NO2 and BTEX exposure levels via compact passive diffusion samplers in female participants from Cape Town, and investigate whether exposure levels are associated with cardiovascular risk markers. Overall, the measured air pollutant exposure levels were lower compared to international standards. NO2 was positively associated with systolic and diastolic blood pressure (SBP and DBP), and inversely associated with the central retinal venular equivalent (CRVE) and mean baseline brachial artery diameter. o-xylene was associated with DBP and benzene was strongly associated with carotid intima media thickness (cIMT). Our findings showed that personal air pollution exposure, even at relatively low levels, was associated with several markers of cardiovascular risk in women residing in the Cape Town region.
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Affiliation(s)
- Frans Everson
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium.
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nandu Goswami
- Division of Physiology, Otto Loewi Research Center of Vascular Biology, Immunity and Inflammation, Medical University of Graz, 8036 Graz, Austria
| | - Mashudu Mthethwa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Dries S Martens
- Centre for Environmental Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Nyiko Mashele
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Sana Charania
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Festus Kamau
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
| | - Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O. Box 241, Cape Town 8000, South Africa
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Sarkar S, Corso P, Ebrahim-Zadeh S, Kim P, Charania S, Wall K. Cost-effectiveness of HIV Prevention Interventions in Sub-Saharan Africa: A Systematic Review. EClinicalMedicine 2019; 10:10-31. [PMID: 31193863 PMCID: PMC6543190 DOI: 10.1016/j.eclinm.2019.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/04/2019] [Accepted: 04/10/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa carries the highest HIV burden globally. It is important to understand how interventions cost-effectively fit within guidelines and implementation plans, especially in low- and middle-income settings. We reviewed the evidence from economic evaluations of HIV prevention interventions in sub-Saharan Africa to help inform the allocation of limited resources. METHODS We searched PubMed, Web of Science, Econ-Lit, Embase, and African Index Medicus. We included studies published between January 2009 and December 2018 reporting cost-effectiveness estimates of HIV prevention interventions. We extracted health outcomes and cost-effectiveness ratios (CERs) and evaluated study quality using the CHEERS checklist. FINDINGS 60 studies met the full inclusion criteria. Prevention of mother-to-child transmission interventions had the lowest median CERs ($1144/HIV infection averted and $191/DALY averted), while pre-exposure prophylaxis interventions had the highest ($13,267/HIA and $799/DALY averted). Structural interventions (partner notification, cash transfer programs) have similar CERs ($3576/HIA and $392/DALY averted) to male circumcision ($2965/HIA) and were more favourable to treatment-as-prevention interventions ($7903/HIA and $890/DALY averted). Most interventions showed increased cost-effectiveness when prioritizing specific target groups based on age and risk. INTERPRETATION The presented cost-effectiveness information can aid policy makers and other stakeholders as they develop guidelines and programming for HIV prevention plans in resource-constrained settings.
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Affiliation(s)
- Supriya Sarkar
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Corresponding author at: Department of Epidemiology, Emory University, Atlanta 30322, USA.
| | - Phaedra Corso
- Department of Health Policy and Management, Kennesaw State University, Kennesaw, GA, USA
| | | | - Patricia Kim
- cDepartment of Economics, Emory University, Atlanta, GA, USA
| | - Sana Charania
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kristin Wall
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Strijdom H, Goswami N, De Boever P, Nawrot T, Essop M, Mthethwa M, Mashele N, Everson F, Charania S, Espach Y, Webster I. Determinants of endothelial function in a cohort of HIV-infected and HIV-free participants: The role of cardiovascular risk factors, biomarkers of inflammation and HIV-dependent parameters. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Strijdom H, Charania S, Goswami N, De Boever P, Nawrot T, Mashele N, Webster I, Westcott C, Everson F, Mthethwa M, Essop F. Cardiovascular health and flow-mediated dilatation (FMD) in a South African cohort of HIV-infected participants-findings from the endoAfrica study. Atherosclerosis 2017. [DOI: 10.1016/j.atherosclerosis.2017.06.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Morris M, O'Neill A, Gillis A, Charania S, Fitzpatrick J, Redmond A, Rosli S, Ridgway P. Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland. J Med Educ Curric Dev 2016; 3:10.4137_JMECD.S39381. [PMID: 29349313 PMCID: PMC5736273 DOI: 10.4137/jmecd.s39381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/23/2016] [Accepted: 03/25/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice. METHODS The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year. RESULTS Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure. CONCLUSION These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.
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Affiliation(s)
- M. Morris
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
| | - A. O'Neill
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - A. Gillis
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - S. Charania
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - J. Fitzpatrick
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - A. Redmond
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - S. Rosli
- School of Medicine, Trinity Biomedical Sciences Institute, Dublin, Ireland
| | - P.F. Ridgway
- Education Division, School of Medicine, Trinity College, Tallaght Campus, Tallaght, Dublin, Ireland
- Department of Surgery, Tallaght Hospital, Tallaght, Dublin, Ireland
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Charania S, Siddiqui PM, Hayat L. A study of urinary infections in school going female children. J PAK MED ASSOC 1980; 30:165-7. [PMID: 6777522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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